World Neurosurg
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Intraoperative ventriculostomy in the surgical management of aneurysmal subarachnoid hemorrhage (SAH) is frequently performed to reduce increased intracranial pressure. The previously suggested ventriculostomy points have some limitations because the dura mater must be opened to be accessed and it is difficult to measure the exact entry point in patients with brain edema. We propose a new intraoperative ventriculostomy point (K point) for use in the surgical management of aneurysmal SAH patient with severe brain edema. ⋯ K point ventriculostomy allows for easy access to a target point and protects the brain during opening of the dura mater and drilling of the sphenoid bone.
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Sellar germ cell tumors (GCTs) occur more frequently in childhood. Some will present as malignancy with infiltration and metastasis. However, the association between the timeliness of diagnosis and outcome has been controversial. We investigated the clinical risk factors associated with a diagnostic delay in patients with sellar GCTs in China. ⋯ A significant proportion of patients with sellar GCTs will experience a delay in the time to diagnosis. Although a delay in diagnosis did not reduce the survival time or progression-free survival time for patients with sellar GCTs, it might increase the risk of short stature. Thus, a detailed medical history and an immediate radiological examination are important for the early diagnosis of sellar GCTs in childhood.
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Acoustic neuromas (ANs) are benign intracranial tumors that arise from myelin-forming Schwann cells surrounding the vestibular branch of the vestibulocochlear nerve (cranial nerve VIII). Treatment options for AN include observation, radiosurgery, and microsurgical resection. Gamma Knife radiosurgery (GKRS) for AN has well-documented short-term safety and efficacy for carefully selected patients. Recent innovations in GKRS technology may improve long-term outcomes. The aim of this study was to report long-term tumor control and complication rates after GKRS for sporadic AN. ⋯ Patients undergoing GKRS for sporadic ANs had high rates of tumor control over a median follow-up time of >5 years. Improvements in radiosurgery treatment planning were seen in the most recent cohort of patients. GKRS is a safe and effective modality for treating sporadic ANs in selected patients.
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Extracerebral neuroglial heterotopias are rare manifestations of cerebral tissue outside the brain whose most common form is the so-called nasal glioma. In this case report we illustrate the first case of heterotopic neuroglial tissue within the bone of the skull. ⋯ The pathogenesis of cerebral heterotopias is diverse. Most of the midline lesions are probably residuals of former meningoencephaloceles. The pathogenesis of extracranial nonmidline lesions is more questionable. Their cause might be a former trauma, inflammatory disease, or surgery. Another option is that they represent primary neuroglial heterotopias, as it is supposed for manifestations of the lung. The coexistence of a heterotopia and a meningioma in this case is probably a coincidence. It is also debatable whether the broad tumor extension within the bone and/or the heterotopia might go back to alterations of the bone structure.
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Primary dural-based lymphoma is a rare disease entity. It has been hypothesized that patients with sarcoidosis are at increased risk of developing lymphoma, an association known as "sarcoidosis-lymphoma syndrome," although dural disease has not yet been reported in the literature. ⋯ Given the association between sarcoidosis and lymphoma, we suggest lymphoma to be considered as one of the top differentials for a dural-based mass lesion in patients with sarcoidosis.